Ambulatory blood pressure monitoring in paediatric patients treated by regular haemodialysis and peritoneal dialysis

Abstract

Ambulatory blood pressure monitoring (ABPM) has been shown to be more representative of blood pressure (BP) levels than casual BP measurements in adult patients treated by haemodialysis (HD). In this study we compared ABPM using the oscillometric SpaceLabs 90207 monitor with casual BP measurements in 35 paediatric patients [17 treated by peritoneal dialysis (PD) and 18 by HD]. Heart rate and plasma concentrations of atrial natriuretic peptide were also measured. No correlations were found between ABPM and causal BP measurements, except for systolic day-time BP in PD patients (r = 0.63). Seventy percent of PD and 33% of HD patients were regarded as hypertensive when evaluated by ABPM, while casual BP measurements demonstrated hypertension in 47% (P < 0.05) of PD patients and in 44% (NS) of HD patients. One-third of patients were reclassified by ABPM either from normotensive to hypertensive (7/19) or from hypertensive to normotensive (5/16). BP assessed by ABPM was higher in PD than in HD patients. The physiological decline of BP at night was significant and more pronounced in PD than in HD patients. In HD patients day-time BP did not differ between the 1st and the 2nd interdialytic day, but increased in the night hours before the following dialysis session. A positive correlation was found between day-time BP and pre-dialysis plasma atrial natriuretic peptide in both treatment groups. In conclusion this study demonstrates that casual BP recordings are not representative of average BP in dialysed paediatric patients. ABPM is useful in the diagnosis and treatment of hypertension in children with end-stage renal disease.

Hypertension in Pediatric Long-term Hemodialysis Patients in the United States

“…In a study of 18 pediatric hemodialysis patients, no correlation was found between ambulatory and predialysis BP measurements (22). In five patients, BP assessed by predialysis recordings was overestimated, and in three it was underestimated compared with ambulatory measurements (22). In a study of 12 pediatric hemodialysis patients, a modest correlation of approximately 0.5 was found between casual and am- bulatory BP measurements for both systolic and diastolic BP (23).…”

“…Data on ambulatory BP monitoring in pediatric hemodialysis patients are limited. In a study of 18 pediatric hemodialysis patients, no correlation was found between ambulatory and predialysis BP measurements (22). In five patients, BP assessed by predialysis recordings was overestimated, and in three it was underestimated compared with ambulatory measurements (22).…”

Ambulatory blood pressure monitoring in haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients

“…In most of the comparative studies for BP control, it was reported that hypertension is better controlled by haemodialysis than CAPD. 6,8,16 However, Rodby et al 9 reported haemodialysis is associated with higher systolic blood pressures than peritoneal dialysis. The differences in the results of the studies are probably due to the differences in volume status of the patients.…”

“…ABPM allows a better assessment in the course of BP levels during the day. 5,6 It was also reported that abnormal BP rhythm, which is common in patients with endstage renal failure, might be associated with target organ damage resulting from hypertension in women. 7 Numerous studies with 24-h ABPM have been reported in haemodialysis and CAPD patients.…”

Long-term outcome of chronic dialysis in children

“…A single 'office' BP may underestimate the true prevalence of hypertension, and ambulatory BP monitoring is increasingly used to diagnose and manage hypertension in dialysis patients [88][89][90].…”